title: Diagnoses of gastrointestinal cancers after gastrointestinal bleeding in patients receiving clopidogrel or warfarin.
abstract: OBJECTIVE
  The association between gastrointestinal (GI) bleeding and subsequent detection of GI cancer in patients using antiplatelet/anticoagulant medications is unclear. We investigated the association between the occurrence of GI bleeding and the detection of GI cancer and assessed whether this association differs in patients treated with clopidogrel or warfarin compared to non-treated patients.
  
  
  METHODS
  A claims analysis was conducted using the Truven Health MarketScan(®) Research databases. Patients were grouped into the treatment cohort if they received a prescription for clopidogrel or warfarin or into the non-treatment cohort if they did not receive these medications. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for GI cancer diagnosed after GI bleeding.
  
  
  RESULTS
  Overall, in the treatment cohort, patients who experienced a GI bleed were 6 times (HR: 5.64, 95% CI, 5.12, 6.21) more likely to be diagnosed with GI cancer compared with those without bleeding. In the non-treatment cohort patients were 13 times (HR: 13.34, 95% CI, 12.21, 14.58) more likely to be diagnosed with GI cancer after GI bleeding. The HRs of GI cancer were higher within 6 months of the first GI bleed and decreased remarkably thereafter.
  
  
  CONCLUSIONS
  This study suggests that an episode of GI bleeding increased the rates of detection of GI cancers.
authors.affiliation: Office of Risk Management & Pharmacoepidemiology (ORMP), Global Patient Safety, Eli Lilly UK, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK. alex.asiimwe@lilly.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Asiimwe
authors.forename: Jian J
authors.initials: JJ
authors.lastname: Li
authors.forename: Govinda
authors.initials: G
authors.lastname: Weerakkody
authors.forename: Harald
authors.initials: H
authors.lastname: Vangerow
authors.forename: Frank
authors.initials: F
authors.lastname: Delisle
authors.forename: Karin
authors.initials: K
authors.lastname: Benoit
authors.forename: Lori
authors.initials: L
authors.lastname: Heath
authors.forename: Joachim
authors.initials: J
authors.lastname: Wernicke
authors.forename: Stephen
authors.initials: S
authors.lastname: Motsko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000077144:Clopidogrel; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine